การศึกษาลักษณะที่พบจากภาพถ่ายเอกซเรย์คอมพิวเตอร์ ความละเอียดสูงของทรวงอกในผู้ป่วยโรคหนังแข็งในโรงพยาบาลมหาราชนครเชียงใหม่

Abstract

Purposes: To detect and characterize pulmonary and associated findings in early systemic sclerosis patients, between two groups (dcSSc vs lcSSc) in Maharaj Nakorn Chiangmai Hospital using high-resolution computed tomography (HRCT). Materials and Methods: The medical records of all patients with SSc who presented at the Rheumatology Clinic, Chiang Mai University Hospital, from December 2009 to March 2013 were underwent HRCT of the chest indicated for interstitial lung disease. Both clinical data and imaging were retrospectively reviewed. The extent of ground glass and lung fibrosis were scored. All scores were aggregated to produce a total CT perfusion score. The widest coronal esophageal diameter (WED), the maximum diameter of the main pulmonary artery (MPAD), right pulmonary artery left pulmonary artery, ascending aortic diameter (AD), cardiothoracic ratio, right ventricle diameter to left ventricle diameter ratio were measured. The ratio of MPAD to AD (MPAD/AD) was calculated. Results: Of the 113 patients with SSc, mean(SD) age and the mean (SD) disease duration from clinical symptom to undergoing the HRCT are 53.4(8.4) years and 13.0 (10) months, respectively. Of them 58.4% are female and 78.8% are classified having dcSSc. There is a significantly higher proportion of the female sex in the lcSSc subgroup(F: M = 7:1) than those in the dcSSc subgroup (F:M =1:1) with p=0.001. There is also significant different of mean disease duration to date of the first HRCT(SD) ( 18.7±11.6 vs.11.4±9.4, p=0.002). The most common HRCT diagnosis of the SSc patients is nonspecific interstitial pnuemoanitis (NSIP) about 55.8%. Most common findings are ground glass opacity(75.2%) and linear or reticulation(79.6%). No significant difference of the presence of linear and reticulation and honey combing but significantly more present of GGO and bronchiectasis in dcSSc subgroup as compared to the lcSSc subgroup (82% vs.50%, p= 0.001 and 47.2% vs.16.7%, p=0.007, respectively). There is significantly more higher calculated HRCT score in dcSSc as compared to lcSSc subgroup with respect to the t-GGO.(3.9±4.2 vs. 1.8±2.5, p=0.006), t-Fib (4.1±3.3 vs. 2.1±2.4, p=0.007) and the CT-total (8.0±6.9 vs. 4.0±4.8, p=0.002). Esophageal dilatation presents in 68.1% and about 48.7% are found below the level of diaphragmatic hiatus. Both subtypes have comparable measurements of the maximal WED and WED at all 3 levels on the HRCT. The t-GGO, the t-fib and the CT-total HRCT score show a significantly positive correlation with the WED. (r=0.275, 0.303 and 0.297, p<0.01). The MPAD, right pulmonary artery and left pulmonary diameter and the MPAD/AD ratio are indistinguishable between both subtypes. The t-fib and CT-total are positive significantly low correlation with the MPAD (r= 0.296 and 0.245, p<0.01, respectively).The cardiothoracic ratio and RV/LV ratio are indistinguishable between both subgroup. There is positive correlation between t-GGO, t-fib and CT-total with the cardiothoracic ratio (r=0.397, 0.518 and 0.471, p<0.01, respectively). There is negative significant low correlation between t-fib with the RV/LV ratio. (r=-0.185 , p<0.05). About 54% reveal lymphadenopathy and the most common station is right lower paratrachealstation 4R(50.8%). Conclusion: The time from the disease duration to the date of first HRCT is different in two subgroup which the GGO and bronchiectasis are more pronounced on dcSSc as well as WED and calculated HRCT score can be distinguishable between dcSSc and lcSSc in early stage. Some small correlation between the t-fib and total-CT score with the MPAD which may use for predicting pulmonary hypertension in early onset of the SSc with parenchymal lung disease Keywords: systemic sclerosis, high-resolution computed tomography, interstitial lung disease, and esophageal dilatation